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i DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR MONTHLY VISUAL INSPECTION CHECKLIST Facility Name Quik Stop Market#138 Date April 8, 2014 Facility Address 1153 Lincoln Blvd. City,State,zip Tracy,CA 95376 Designated Operator Culp,William ICC Gerlification# 8251286 Expiration March 18,2016 Signature , ?,,;�� i- -4 Phone (916)826-3066 Item MONITORING PANEL-/ ALARM HISTORY _Y N NA 1 Monitoring system is powered on and in proper operating mode. ■ ❑ ❑ 2 Monitoring system is NOT currently showing any alarms or warnings. ■ ❑ ❑ 3 Alarm history report/tog for the previous month is available,and has been reviewed by the Designated UST Operator. ■ ❑ ❑ 3a Is a copy of the alarm history report/log to this form? ■ ❑ ❑ 4 Each alarm for the previous month has been responded to appropriately. ❑ ❑ ■ 5 Sensors located in tank-top containment sumps have NOT alarmed in the past month. ■ ❑ ❑ 5a List all tank-top sumps where alarms occurred in the past month: r Note: Sumps where an alarm has occurred in the past month must be inspected unless a quahtied service technician responded to,and properly addressed,the cause o/the alarm. Attach documentation verifying appropriate service to this report. t If suMe i Ghon is re wired,record results in item 6 below. f UST SYSTEM INSPECTION 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. Note: visual inspection of sumps is only required in sumps are an alarm has occurred in the past month for which there is no service record. YN Sump Location: ❑ ❑ Sump Location: ❑ ❑ Sump Location: — _ ..0. -0- 7 0 7 Spill Containment Structures are free of water,debris, and hazardous substance. Y N NA Y N NA Tank 1 - Gasoline 87 ■ ❑ ❑ Tank 3 - Gasoline 91 ■ ❑ ❑ Tank 2 - Gasoline 89 ■ ❑ ❑ 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properly. Y N NA Dispenser 1/2 ■ ❑ ❑ Dispenser 3/4 ■ ❑ ❑ PAPERWORK INSPECTION Date I Y I N I NA 9 Monitoring system certification has been completed within the past 12 months. 08/23/13 ■ ❑ ❑ 10 Secondary containment tests have been completed within the required timeframe. 07/25/13 ■ ❑ ❑ 11 Spill containment structure(bucket)testing was completed within the past year. 08/23/13 ■ ❑ ❑ 12 Tank tightness testing was completed within the required timeframe. ❑ ❑ ■ 13 Line tightness testing was completed within the required timeframe. ❑ ❑ ■ 14 Other required testing/maintenance was completed within the required timeframe. (List items below) Test/Maintenance Air Quality Test 09/05/13 ■ ❑ ❑ Test/Maintenance ❑ ❑ ❑ FACILITY EMPLOYEE TRAINING Y N NA .mm I 15 All facility employees have received the required on-the-job training within the past year. ■ ❑ ❑ 16 All facility employees hired within the past 30 days have received the required on-the-job training. 101 ❑ ■ 02014 W",-..,_ Page 1 Checklist P1